MEDICARE: MANDY ANGELES KENNY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH-5173	HI

General Provider Information

NPI Number	:	1134071160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY ANGELES KENNY PHARMD

Provider Business Mailing Address
First Line	:	94-202 LOKU PL
Second Line	:
City	:	WAIPAHU
State	:	HI
Zip	:	96797-5534
Country	:	US
Telephone Number	:	913-940-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 KUALA ST
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2959
Country	:	US
Telephone Number	:	808-456-5302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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